Overview of Trigeminal Neuralgia

Understanding the Severe Pain, Where it Comes From, and How to Treat It

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Learn about the stabbing pain of trigeminal neuralgia. Denis Kartavenko/Getty Images

Sometimes when people describe headaches, they are actually describing facial pain. While there are a number of different types of facial pain syndromes, the most common one is trigeminal neuralgia.

Although still rare in occurrence, trigeminal neuralgia affects the trigeminal nerve – a nerve that provides sensation to the face and helps control jaw movement.

If you are a sufferer of trigeminal neuralgia, you know better than anyone else, the tremendous, sudden, and electric-shock-like pain this disorder causes.

 

Trigeminal Nerve

The trigeminal nerve is cranial nerve 5 of 12. It sends sensory information to the face and also helps control the muscles of chewing. The trigeminal nerve has three major branches:

  • ophthalmic (near the eye)
  • maxillary (cheek-area)
  • mandibular (jaw-area).

The branches of the trigeminal nerve most commonly affected in trigeminal neuralgia are the maxillary or mandibular branch. This is why people with trigeminal neuralgia will commonly complain of tooth pain – and even undergo painful and expensive dental procedures before being correctly diagnosed.

Pain of Trigeminal Neuralgia

The pain of trigeminal neuralgia occurs in spasms and lasts one to many seconds. The pain almost always affects just one trigeminal nerve in the face – you have one on each side – but it can rarely affect both. While trigeminal neuralgia is more common in women and people over the age of 50, it can affect young adults and children.

Causes of Trigeminal Neuralgia

Most cases are caused by compression of the trigeminal nerve root, usually by an abnormal loop of an artery or vein in the face. 

There are also seconday causes of trigeminal neuralgia. For instance, sometimes a tumor can cause compression of the trigeminal nerve. Inflammation of the nerve – like that which occurs in multiple sclerosis – can also cause trigeminal neuralgia.

Triggers of Trigeminal Neuralgia

It is common for certain activities to trigger the attacks of pain. Examples include:

  • Chewing
  • Brushing your teeth
  • Smiling
  • Talking or laughing
  • Shaving
  • Exposure of your face to cold air
  • Light touching of the face

 Diagnosis of Trigeminal Neuralgia

Your primary care physician or neurologist will make the diagnosis. Often brain imaging (like a brain MRI) is needed to rule out secondary causes like a tumor or multiple sclerosis first.

Treatment of Trigeminal Neuralgia

Treatment is usually with an anti-seizure medication called carbamazepine. While often quite effective, it does carry some potential adverse effects (especially with higher doses which some people may need over time). Examples of these adverse effects include:

  • drowsiness
  • dizziness
  • nausea
  • vomiting

In addition, two rare side effects of carbamazepine are a low number of white blood cells (infection-fighting cells) or aplastic anemia – a disorder that affects your bone marrow where blood cells are produced.

In addition, certain individuals – particularly people of Asian descent who carry a certain genetic marker - may be at an increased risk of developing a potentially fatal skin disorder called Stevens-Johnson syndrome and/or toxic epidermal necrolysis.

If you are of Asian ancestry, your doctor will most likely test you for this gene before prescribing carbamazepine.

Your doctor may also consider other medications like oxcarbazepine – a newer drug that is similar in structure to carbamazepine and may have less side effects. Sometimes baclofen, a muscle relaxant, is also prescribed and can be used in addition to carbamazepine - although it can also cause drowsiness, a double whammy.

If you continue to suffer from trigeminal neuralgia, despite optimal medical therapy, or if you cannot tolerate the side effects of medications, your neurologist may refer you for surgery. The good news is that there are a number of surgical procedures available. That being said, it's still surgery and carries risks so requires a careful discussion with your neurologist and surgeon.

The Bottom Line

If you are diagnosed with trigeminal neuralgia, be hopeful and ensure you follow closely with your neurologist. While it may not be able to be cured, you can effectively manage it and move forward with your life. 

Sources:

Bajwa ZH, Ho CC, Khan SA. Trigeminal Neuralgia. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014.

Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183-1190.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;24(9):629-808.

Zakrzewska JM, Linksey ME. Trigeminal neuralgia. BMJ. 2014 Feb 17;348:g474.

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